Legal claims defining the scope of protection. Each claim is shown in both the original legal language and a plain English translation.
1. A computer-implemented method in a server of processing an insurance claim associated with a long-term care insurance policy held by a customer residing in a property, the property populated with a plurality of devices and a hardware controller connected to the plurality of devices, each of the plurality of devices incorporating at least one sensor, the method comprising: receiving, by the server, an insurance claim for the long-term care insurance policy, the insurance claim initiated by a caregiver and indicating a set of purported services performed by the caregiver; determining, from the insurance claim, at least a portion of the set of purported services that are verifiable; identifying at least a portion of the plurality of devices that corresponds to at least the portion of the set of purported services; sending, from the server to the hardware controller via a network connection, a request for a set of data collected by at least the portion of the plurality of devices, wherein the hardware controller relays the request, via a local communication network, to at least one of (i) at least the portion of the plurality of devices or (ii) a database associated with the hardware controller, the database storing the set of data collected by at least the portion of the plurality of devices, wherein the request includes a set of specific time periods associated with when the set of purported services were performed; receiving, by the server from the hardware controller via the network connection, the set of data collected by at least the portion of the plurality of devices, the set of data transmitted, to the hardware controller via the local communication network, from at least one of (i) at least the portion of the plurality of devices or (ii) the database associated with the hardware controller, the set of data indicating, for each of at least the portion of the plurality of devices, a set of activations and deactivations of the at least one sensor incorporated into the respective device; analyzing, for each of at least the portion of the plurality of devices by at least one processor of the server, the set of activations and deactivations of the at least one sensor incorporated into the respective device; based on analyzing the set of activations and deactivations, calculating a set of time periods during which each of at least the portion of the plurality of devices was activated; determining a set of actual services performed within the property including, for each of the set of time periods, comparing the respective time period to a requisite time period associated with a service performance; comparing, by the one or more processors, the set of purported services to the set of actual services; and after the comparing, causing an electronic device to display, in a user interface, a monetary amount of the set of purported services and a monetary amount of the set of actual services, wherein the user interface further displays, concurrently with the monetary amount of the set of purported services and the monetary amount of the set of actual services, (i) a selection for approving the insurance claim, (ii) a selection for denying the insurance claim, and (iii) a selection for further inquiring about the insurance claim.
This invention relates to a system for verifying and processing insurance claims for long-term care services using sensor-equipped devices in a property. The system addresses the problem of fraudulent or inaccurate claims by caregivers by leveraging data from IoT devices to validate the services performed. The method involves a server receiving an insurance claim initiated by a caregiver, which includes a set of purported services. The server identifies verifiable services from the claim and determines which devices in the property correspond to those services. The server then requests data from a hardware controller connected to the devices, specifying time periods when the services were allegedly performed. The hardware controller retrieves sensor activation and deactivation data from the devices or a local database, which the server analyzes to calculate actual service time periods. The system compares the purported services to the actual services based on sensor data and displays the results in a user interface, showing monetary amounts for both. The interface provides options to approve, deny, or further investigate the claim. This approach ensures accurate claim processing by cross-referencing caregiver reports with objective sensor data from the property's devices.
2. The computer-implemented method of claim 1 , wherein comparing the set of purported services to the set of actual services comprises: identifying, from the insurance claim, the monetary amount of the set of purported services; calculating, based on the set of actual services, the monetary amount of the set of actual services; and comparing the monetary amount of the set of purported services to the monetary amount of the set of actual services.
This invention relates to automated fraud detection in insurance claims processing, specifically for identifying discrepancies between billed services and actual services rendered. The system analyzes insurance claims to detect potential fraud by comparing purported services submitted by healthcare providers with verified actual services. The method involves extracting the monetary value of the purported services from the claim data and calculating the monetary value of the actual services based on verified records. These values are then compared to identify discrepancies that may indicate fraudulent billing. The comparison process ensures that the financial amounts associated with the services are accurately assessed, allowing for precise detection of overbilling or misrepresentation. This approach enhances fraud detection by focusing on monetary discrepancies, which are common indicators of fraudulent activity in healthcare claims. The system automates the verification process, reducing manual review time and improving accuracy in identifying fraudulent claims.
3. The computer-implemented method of claim 2 , wherein comparing the monetary amount of the set of purported services to the monetary amount of the set of actual services comprises: determining that the monetary amount of the set of purported services differs from the monetary amount of the set of actual services by at least a threshold amount.
This invention relates to a computer-implemented method for detecting discrepancies in financial transactions, specifically comparing the monetary amounts of purported services (e.g., billed or invoiced services) against actual services (e.g., services rendered or delivered). The method addresses the problem of financial inaccuracies, such as overbilling or underbilling, by identifying significant differences between the expected and actual monetary values associated with services. The method involves analyzing a set of purported services, which may include invoiced amounts or billed charges, and a corresponding set of actual services, which may represent the true value of services provided. The core functionality involves comparing these two sets to determine if the monetary difference exceeds a predefined threshold amount. If the difference meets or exceeds this threshold, the system flags the discrepancy, enabling further investigation or correction. This approach ensures financial accuracy by automating the detection of significant billing discrepancies, reducing manual review efforts, and mitigating potential financial losses or disputes. The threshold-based comparison allows for flexibility in defining what constitutes a meaningful discrepancy, adapting to different industries or transaction types. The method may be integrated into financial systems, billing platforms, or auditing tools to enhance transparency and accuracy in financial transactions.
4. The computer-implemented method of claim 1 , wherein comparing the set of purported services to the set of actual services comprises: identifying at least one of the set of purported services that is not included in the set of actual services.
This invention relates to a computer-implemented method for detecting discrepancies between purported services and actual services in a system. The method addresses the problem of ensuring that services advertised or expected to be available in a system match the services that are actually operational. This is particularly relevant in environments where service availability is critical, such as cloud computing, distributed systems, or service-oriented architectures. The method involves comparing a set of purported services (those expected or advertised to be available) with a set of actual services (those confirmed to be operational). The comparison process includes identifying at least one service from the purported set that is missing from the actual set. This discrepancy detection helps in identifying misconfigurations, failures, or unauthorized changes in the system. The method may also involve generating alerts or triggering corrective actions when such mismatches are found. The invention ensures system reliability by verifying that all expected services are functioning as intended, reducing downtime and improving operational transparency. It can be applied in various contexts, including service discovery, monitoring, and validation in dynamic computing environments. The method may be integrated into existing service management frameworks or deployed as a standalone verification tool.
5. The computer-implemented method of claim 1 , further comprising, after the comparing, processing the insurance claim including at least one of: approving the insurance claim; flagging the insurance claim; denying the insurance claim; and contacting the caregiver.
This invention relates to automated insurance claim processing, specifically for claims involving medical services provided by caregivers. The system addresses inefficiencies in manual review processes by using automated comparison techniques to assess claim validity. The method involves analyzing an insurance claim to extract relevant data, such as patient information, service details, and billing codes. This data is then compared against predefined criteria, which may include medical necessity guidelines, billing regulations, or historical claim patterns. The comparison determines whether the claim meets approval standards, identifies discrepancies, or flags potential fraud. After the comparison, the system processes the claim through one or more actions: approving the claim for payment, flagging it for further review, denying it if it fails validation, or contacting the caregiver for additional information. The system may also integrate with external databases or regulatory sources to verify claim accuracy. The automated approach reduces processing time, minimizes human error, and improves compliance with insurance policies. The invention is particularly useful in healthcare insurance, where rapid and accurate claim resolution is critical for both providers and patients.
6. The computer-implemented method of claim 1 , wherein comparing the respective time period to the requisite time period associated with the service performance comprises: determining that the respective time period at least meets the requisite time period associated with the service performance.
This invention relates to a computer-implemented method for evaluating service performance by comparing time periods associated with service tasks. The method addresses the problem of assessing whether a service meets predefined performance criteria based on time-based metrics. Specifically, it determines whether the time taken to complete a service task meets or exceeds a required time period associated with that service. The method involves analyzing a service performance by comparing the actual time period taken to complete a task against a predefined requisite time period. The comparison step includes verifying that the actual time period is at least equal to or greater than the requisite time period. This ensures that the service meets or exceeds the expected performance threshold. The method may also involve additional steps such as monitoring service tasks, recording time data, and generating performance reports, though these are not explicitly detailed in the claim. The invention is particularly useful in industries where service performance is critical, such as customer support, logistics, or manufacturing, where adherence to time-based service level agreements (SLAs) is essential. By automating the comparison process, the method reduces manual effort and improves accuracy in performance evaluations. The system may be integrated into existing service management platforms to provide real-time performance tracking and compliance monitoring.
7. The computer-implemented method of claim 1 , further comprising: determining, from the insurance claim, an additional portion of the set of purported services that are not verifiable.
This invention relates to automated verification of insurance claims, specifically addressing the challenge of identifying unverifiable services within a submitted claim. The method involves analyzing an insurance claim to detect services that cannot be verified against available data sources. This includes cross-referencing the claimed services with medical records, billing codes, or other relevant databases to confirm their validity. The system flags services that lack sufficient supporting evidence or do not match expected standards, such as those that are medically unnecessary, improperly coded, or fraudulent. By isolating unverifiable services, the method helps insurers reduce fraudulent payouts and improve claim accuracy. The process may involve machine learning models trained to recognize patterns of fraudulent or erroneous claims, as well as rule-based checks for common discrepancies. The system may also prioritize unverifiable services for further review by human auditors, ensuring efficient resource allocation. This approach enhances claim processing efficiency while minimizing financial losses due to invalid claims.
8. The computer-implemented method of claim 1 , wherein identifying at least the portion of the plurality of devices that corresponds to at least the portion of the set of purported services comprises: identifying, based on a data record associated with the long-term care insurance policy, at least the portion of the plurality of devices that corresponds to at least the portion of the set of purported services.
This invention relates to a computer-implemented method for managing long-term care insurance policies by identifying devices associated with purported services covered under the policy. The method addresses the challenge of accurately determining which devices correspond to specific services claimed under a long-term care insurance policy, ensuring proper coverage and fraud prevention. The method involves analyzing a data record linked to the long-term care insurance policy to identify a subset of devices from a larger group that aligns with a subset of purported services. This ensures that only relevant devices are considered for coverage, reducing errors and fraudulent claims. The data record may include details such as device types, service categories, and policy terms, enabling precise matching between devices and services. By leveraging this data-driven approach, the method enhances the accuracy and efficiency of service validation in long-term care insurance claims processing. The solution is particularly useful in environments where multiple devices and services must be tracked and verified against policy terms.
9. The computer-implemented method of claim 1 , wherein the set of data includes motion detection data indicating presence information.
The invention relates to computer-implemented methods for processing data, particularly for analyzing motion detection data to determine presence information. The method involves collecting a set of data that includes motion detection data, which is used to detect and track the presence of objects or individuals within a monitored area. The motion detection data may be derived from sensors such as cameras, radar, or other motion-sensing devices. The system processes this data to identify patterns, movements, or changes that indicate the presence of an object or person, distinguishing between relevant motion and background noise. This presence information can be used for applications such as security monitoring, occupancy detection, or automated environmental control. The method may also integrate additional data sources, such as environmental sensors or user inputs, to enhance accuracy and context. The system dynamically adjusts its analysis based on the detected motion patterns, ensuring reliable presence detection even in varying conditions. The invention improves upon existing systems by providing a more robust and adaptive approach to motion-based presence detection, reducing false positives and enhancing real-time responsiveness.
10. The computer-implemented method of claim 1 , wherein comparing, by the one or more processors, the set of purported services to the set of actual services comprises: determining a set of discrepancies between the set of purported services and the set of actual services.
This invention relates to a computer-implemented method for verifying service delivery in a networked system. The problem addressed is ensuring that services advertised or billed to a customer match the services actually provided by a service provider. The method involves comparing a set of purported services (e.g., services billed or advertised) with a set of actual services (e.g., services confirmed to be delivered) to identify discrepancies. The comparison process includes analyzing the two sets to detect mismatches, such as overbilling, missing services, or incorrect service configurations. The method may also involve generating alerts or reports for discrepancies, enabling service providers to correct billing errors or service delivery issues. The system may use automated monitoring, logging, or telemetry data to determine the actual services provided. This approach helps improve transparency, reduce billing disputes, and ensure accurate service delivery in telecommunications, cloud computing, or other service-based industries. The method may be integrated into billing systems, service management platforms, or customer portals to provide real-time or periodic verification of service alignment.
11. A system for processing an insurance claim associated with a long-term care insurance policy held by a customer residing in a property, the property populated with a plurality of devices and a hardware controller connected to the plurality of devices, each of the plurality of devices incorporating at least one sensor, comprising: a communication module for communicating data via a network connection; a memory storing non-transitory computer executable instructions; and a processor interfacing with the communication module and the memory, wherein the processor is configured to execute the non-transitory computer executable instructions to cause the processor to: receive, via the communication module, an insurance claim for the long-term care insurance policy, the insurance claim initiated by a caregiver and indicating a set of purported services performed by the caregiver, determine, from the insurance claim, at least a portion of the set of purported services that are verifiable, identify at least a portion of the plurality of devices that corresponds to at least the portion of the set of purported services, send, to the hardware controller via the communication module, a request for a set of data collected by at least the portion of the plurality of devices, wherein the hardware controller relays the request, via a local communication network, to at least one of (i) at least the portion of the plurality of devices or (ii) a database associated with the hardware controller, the database storing of the set of data collected by at least the portion of the plurality of devices, wherein the request includes a set of specific time periods associated with when the set of purported services were performed, receive, from the hardware controller via the communication module, the set of data collected by at least the portion of the plurality of devices, the set of data transmitted, to the hardware controller via the local communication network, from at least one of (i) at least the portion of the plurality of devices or (ii) the database associated with the hardware controller, the set of data indicating, for each of at least the portion of the plurality of devices, a set of activations and deactivations of the at least one sensor incorporated into the respective device, analyze, for each of at least the portion of the plurality of devices, the set of activations and deactivations of the at least one sensor incorporated into the respective device, based on analyzing the set of activations and deactivations, calculate a set of time periods during which each of at least the portion of the plurality of devices was activated, determine a set of actual services performed within the property including, for each of the set of time periods, comparing the respective time period to a requisite time period associated with a service performance, compare the set of purported services to the set of actual services, and after the comparing, cause an electronic device to display, in a user interface, a monetary amount of the set of purported services and a monetary amount of the set of actual services, wherein the user interface further displays, concurrently with the monetary amount of the set of purported services and the monetary amount of the set of actual services, (i) a selection for approving the insurance claim, (ii) a selection for denying the insurance claim, and (iii) a selection for further inquiring about the insurance claim.
The system processes insurance claims for long-term care policies by verifying services performed by caregivers using data from smart devices in the insured's property. The property contains multiple devices, each with sensors, connected to a hardware controller. When a caregiver submits a claim detailing purported services, the system identifies verifiable services and the corresponding devices. It requests sensor activation data from the hardware controller, which retrieves it from the devices or a local database, specifying time periods when services were allegedly performed. The system analyzes sensor activations to determine actual service times, compares them to required service durations, and calculates actual services performed. It then compares the purported and actual services, displaying both monetary amounts in a user interface. The interface allows approval, denial, or further inquiry into the claim. This system automates claim verification by leveraging IoT device data to ensure accurate reimbursement for long-term care services.
12. The system of claim 11 , wherein to compare the set of purported services to the set of actual services, the processor is configured to: identify, from the insurance claim, the monetary amount of the set of purported services, calculate, based on the set of actual services, the monetary amount of the set of actual services, and compare the monetary amount of the set of purported services to the monetary amount of the set of actual services.
This invention relates to a system for verifying and comparing medical services in insurance claims. The system addresses the problem of discrepancies between services billed by healthcare providers and the actual services performed, which can lead to fraudulent or erroneous claims. The system includes a processor that analyzes an insurance claim to identify a set of purported services and a set of actual services. The processor then compares these sets to detect inconsistencies. Specifically, the processor identifies the monetary amount associated with the purported services from the insurance claim and calculates the monetary amount of the actual services based on the set of actual services. The system then compares these monetary amounts to determine if there is a mismatch, which may indicate fraud or billing errors. The comparison helps insurers verify the accuracy of claims and reduce financial losses due to overbilling or incorrect service reporting. The system may also include a database storing medical service codes and corresponding monetary values to assist in the comparison process. This verification process ensures that payments are made only for services that were actually performed, improving claim accuracy and reducing fraudulent activities.
13. The system of claim 12 , wherein to compare the monetary amount of the set of purported services to the monetary amount of the set of actual services, the processor is configured to: determine that the monetary amount of the set of purported services differs from the monetary amount of the set of actual services by at least a threshold amount.
This invention relates to a system for detecting discrepancies between purported services and actual services in a financial or transactional context. The system is designed to address the problem of inaccuracies or fraud in service billing, where the amount charged for services does not match the actual services provided. The system includes a processor configured to compare the monetary amounts of purported services (e.g., billed services) and actual services (e.g., verified or recorded services). The comparison process involves determining whether the difference between the two amounts exceeds a predefined threshold, indicating a potential discrepancy. If the difference meets or exceeds this threshold, the system may flag the transaction for review or take corrective action. The system may also include additional components, such as a database for storing service records and a user interface for displaying comparison results. The threshold amount can be set based on factors like industry standards, historical data, or user-defined parameters. This invention aims to improve financial accuracy and reduce fraud by automating the detection of billing discrepancies.
14. The system of claim 11 , wherein to compare the set of purported services to the set of actual services, the processor is configured to: identify at least one of the set of purported services that is not included in the set of actual services.
This invention relates to a system for verifying the accuracy of service offerings, particularly in environments where discrepancies between advertised and actual services can occur. The system addresses the problem of mismatches between services that are purported to be available (e.g., in a service catalog or user interface) and those that are actually operational or accessible. Such discrepancies can lead to user frustration, inefficiencies, and potential security risks. The system includes a processor that compares a set of purported services (e.g., services listed in a database or interface) with a set of actual services (e.g., services confirmed to be operational through monitoring or testing). The comparison process involves identifying at least one service in the purported set that is not present in the actual set, indicating a discrepancy. This helps administrators or automated systems detect and correct inaccuracies in service listings. The system may also include a user interface for displaying the comparison results, allowing users to take corrective actions. The processor may further analyze the discrepancies to determine their cause, such as misconfigurations, outages, or unauthorized changes. The system can be applied in various domains, including cloud computing, software-as-a-service (SaaS), or enterprise IT environments, where maintaining accurate service availability is critical.
15. The system of claim 11 , wherein the processor is configured to execute the non-transitory computer executable instructions to further cause the processor to process the insurance claim, including at least one of: approve the insurance claim, flag the insurance claim, deny the insurance claim, and contact the caregiver.
The system is designed for automated insurance claim processing in healthcare, addressing inefficiencies in manual review and approval workflows. It integrates data from electronic health records (EHRs), insurance databases, and caregiver inputs to streamline claim evaluation. The system analyzes claim details, such as medical codes, treatment justifications, and policy coverage, to determine validity. It includes a processor executing instructions to assess claims, with capabilities to approve, flag for review, deny, or initiate contact with caregivers for additional information. The system may also validate claim accuracy against medical guidelines and insurance policies, reducing errors and fraud. By automating these steps, it accelerates claim resolution while ensuring compliance with regulatory standards. The system enhances transparency and reduces administrative burdens for healthcare providers and insurers.
16. The system of claim 11 , wherein to compare the respective time period to the requisite time period associated with the service performance, the processor is configured to: determine that the respective time period at least meets the requisite time period associated with the service performance.
This invention relates to a system for monitoring and evaluating service performance, particularly in environments where timely execution of tasks is critical. The system addresses the challenge of ensuring that services meet predefined time-based performance criteria, such as response times or task completion deadlines. The system includes a processor that compares a measured time period (the duration taken to complete a service task) against a requisite time period (the expected or required duration for that task). The processor determines whether the measured time period at least meets the requisite time period, meaning the task was completed within the allowed time or faster. This comparison helps assess whether the service performance adheres to specified standards. The system may also include additional components, such as a data storage unit to log service performance metrics and a user interface to display results. The processor can analyze historical data to identify trends, optimize workflows, or trigger alerts if performance falls below acceptable thresholds. The invention is applicable in fields like IT service management, customer support, logistics, and healthcare, where timely service delivery is essential. By automating time-based performance evaluations, the system improves efficiency, reduces manual oversight, and ensures compliance with service-level agreements.
17. The system of claim 11 , wherein the processor is configured to execute the non-transitory computer executable instructions to further cause the processor to: determine, from the insurance claim, an additional portion of the set of purported services that are not verifiable.
This invention relates to an automated system for verifying insurance claims, particularly focusing on identifying unverifiable services within a submitted claim. The system processes insurance claims to assess the validity of purported medical or healthcare services. A processor executes instructions to analyze the claim data, cross-referencing it with external databases or verification protocols to confirm the legitimacy of the services listed. The system flags services that cannot be verified through available records, ensuring only valid claims are processed. This helps prevent fraudulent or erroneous claims from being approved, reducing financial losses for insurers. The system may also generate reports or alerts for further investigation of unverified services, improving claim accuracy and efficiency. The invention addresses the challenge of manual claim verification, which is time-consuming and prone to human error, by automating the process while maintaining high accuracy. The system's ability to identify unverifiable services enhances transparency and accountability in insurance claim processing.
18. The system of claim 11 , wherein to identify at least the portion of the plurality of devices that corresponds to at least the portion of the set of purported services, the processor is configured to: identify, based on a data record associated with the long-term care insurance policy, at least the portion of the plurality of devices that corresponds to at least the portion of the set of purported services.
This invention relates to a system for managing long-term care insurance policies, specifically focusing on verifying and validating services provided under such policies. The system addresses the challenge of ensuring that services billed to an insurance policy are legitimate and correspond to actual care provided by authorized devices or providers. The system includes a processor that identifies a subset of devices from a plurality of devices that are associated with a subset of purported services claimed under the policy. This identification is based on data records linked to the long-term care insurance policy, which may include device registrations, service authorizations, or historical usage data. By cross-referencing these records, the system can determine whether the devices involved in providing the services are authorized and whether the services align with the policy terms. This verification process helps prevent fraudulent claims and ensures that only valid services are reimbursed, thereby improving the accuracy and efficiency of long-term care insurance administration. The system may also include additional features such as real-time monitoring, automated alerts for discrepancies, and reporting tools to enhance oversight and compliance.
19. The system of claim 11 , wherein the set of data includes motion detection data indicating presence information.
A system for monitoring and analyzing motion detection data to determine presence information within a defined area. The system includes sensors, such as cameras or motion detectors, that capture motion data from the environment. This data is processed to identify movement patterns, which are then analyzed to determine whether a person or object is present in the monitored area. The system may also integrate additional data sources, such as environmental sensors or user inputs, to enhance accuracy. The motion detection data is used to generate presence information, which can be utilized for security, automation, or behavioral analysis applications. The system may further include processing units that filter noise, classify motion types, and correlate data across multiple sensors to improve detection reliability. By continuously monitoring and analyzing motion, the system provides real-time or historical insights into occupancy and movement within the monitored space. This technology is particularly useful in smart homes, surveillance systems, and automated environments where presence detection is critical for security or operational efficiency.
20. The system of claim 11 , wherein to compare the set of purported services to the set of actual services, the processor is configured to: determine a set of discrepancies between the set of purported services and the set of actual services.
The system is designed for verifying and comparing service offerings in a networked environment, particularly where discrepancies between advertised (purported) services and actual delivered services may occur. The system operates by analyzing service data from multiple sources to identify mismatches or errors in service provisioning. A processor within the system compares a set of purported services—those that are claimed or advertised to be available—against a set of actual services—those that are confirmed to be operational or delivered. The comparison process involves determining a set of discrepancies, which may include missing services, incorrectly configured services, or services that are advertised but not actually available. The system may also track historical data to identify trends or recurring discrepancies, allowing for proactive adjustments or alerts. This verification process helps ensure service reliability, accuracy in billing, and compliance with service-level agreements. The system may be applied in telecommunications, cloud computing, or other service-based industries where accurate service delivery is critical.
Unknown
December 10, 2019
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